Rural Excursion: Levels of Health Care in Aligarh

This past week we went on a four day excursion to Aligarh, Uttar Pradesh. Along with our cultural adventures (interacting with the women of Aligarh Muslim University, a wedding reception (which I was too sick to attend) and a cultural-music performance), we visited the entire range of health delivery services that exist in India.

Before I continue, let me preface by saying that this is a super detailed and intricate system with many details. I don't plan on going into too much detail here; but as always, if you have a question about something specific, please leave a comment and I'll do my best to respond.

To see the first level of care, we visited a small village.

The very first and basic level of health delivery is provided by the Ashas, a volunteer government position. This level of health care delivery is relatively new (2005) and has been extended to 2017. At that time the system will be reviewed.

An Asha is a woman (who is married and has at least one child) who lives in the community and has leadership ability. Being an Asha is voluntary, but there are certain government perks to meeting goals. The women are elected by the community and they must pass the screening tests. They also receive increased respect from the community and there are reports that say that being an Asha is a source of pride for a woman.

To the right is a picture of a woman with her newborn (40 days old) getting a wellness visit from the Asha. The Asha asks a series of questions like what you would associate with a typical pediatric check up (heart rate, breathing, temperature, rashes, latching for breastfeeding, ect.) but she uses no tools besides a wrist watch. Additionally she educates the mother about proper feeding schedules, hand washing hygiene, and keeping the baby warm.

The Ashas also hold meetings at the village Anganwadi about health skills and practices. Below is a picture of us at the meeting (the local women are sitting with the children). There was also a camera crew there because the sociology department of the local university (Aligarh Muslim University) was making a film about the Ashas work and also about our visit to Aligarh.

The village was one long main road with brick and concrete/cow dung huts on the sides (see the blue and green structures on the left). There were also open spaces such as this, where various activities took place.

In this village (and apparently I am told all over rural areas in India) there are patches of MJ growing freely.

The next level of care takes place at the health Sub-Center (the pink building).

Here, the Auxiliary Nurse Midwife (ANM) provides care to pregnant woman and also gives basic care to villagers.

Birthing table in the Sub-Center.

The Sub-Center here consists of two main rooms and a "bathroom." The first room is the birthing room. One of the main roles of the ANM is to deliver the all of the babies in the areas. Each sub-center is supposed to cover a 1.5km area, but this one covers 3km.

The ANM monitors all the pregnancies to make sure that the women are going to have safe births (otherwise they will be advised to go to a higher level of care for the birth) because there is little to no medical equipment at the subcenter.

The next level is the Primary Health Center (PHC) (picture on the right). This place was quite frustrating to me. It was practically abandoned. This is supposed to be the first level that has a doctor present, but the doctor that is technically working there is actually working and living in Delhi (a two hour train ride away).

Because there is no doctor there, no one comes to the center. All of the beds are empty. There is a guy there whose job is to clean. But because there is no one else there, he also (without any official training) has become the resident pharmacist. There are an amazing amount of issues that arise with this, but this post is already getting too long ...

The pharmacy box at the PHC. The box gets resupplied every six months.

The fourth level is the Community Health Center (CHC).

They have at least 6 doctors and there are a variety of services available including the DOTS program (Directly Observed Therapy - Short Course) for TB treatment.

The outside of the CHC.

The next level is the District Hospital, but I missed that visit because I was too sick to leave the hostel room. But it provides more and broader scale services than the CHC.

One of the waiting rooms at the hospital.

Finally there is the tertiary level health care: the Government Hospitals which also typically include med-schools.

We visited this hospital/school on the last day. Here we visited different outpatient departments (OPDs) and we also talked to the president and dean of the school.

I went to the psychiatry OPD. Which was pretty crazy. Each patient gets seen for about 5 minutes and we saw everything from dandruff to a man who was diagnosed with schizophrenia and was committed into the mental ward.

There was so much to see during this visit. The systems are of course flawed (they are flawed everywhere around the world), but there were many aspects which I found to be ... functional and appropriate.

The problem is that there are simply too many people here in India and not enough money or infrastructure to support good national health.

Despite being overwhelmed by the problems that the country is facing, I felt very encouraged that there are so many programs and people working towards improving the health of the nation. I am finding the intricacies of the systems to be absolutely fascinating.

Oh! This is so long. "So sorry" as the Indians would say.

The Magnificent Taj Mahal

Yesterday was one of the best adventures yet in India. I planned a trip to the Taj Mahal!!!

Clockwise: Me, Julika, Chrissy, Julia, Priyanka, Sarah,
Emily (sleeping already), Michelle, and Erika

The day started at 6:30am when we loaded into a "Tempo Traveler" that I had booked online.

The driver didn't speak much/any English, so it was a tiny bit of a struggle to explain to him that we needed to pick up one of our adventure companions before heading to Agra. But he got the point across and we were off!

A map would tell you that from Delhi to Agra should take about 2.5 hours. Well, double that. It took us FOREVER to get there. Granted we did have a few pauses in the travel. There were some pit stops at gas stations (I am actually diggin' the Eastern style toilet now), and a run in with a monkey/owner.

There is a scam type thing where men have adorable monkeys on leashes and teach them to do tricks. Well, we were stopped on the highway as the driver was dealing with some road tax stuff, and a monkey-guy came next to the car. One of my travel companions decided she wanted to take a picture of the adorable money as she (the monkey) was hanging onto the side of the van with a baby monkey in her arm. That was a mistake. The guy immediately started demanding 100 Rupees. And when I say demanded, I mean he and his friends were banging on the windows and the side of the van, opening a window and putting his hands through and yelling at us about money. Luckily the doors were locked and just as we were getting super uncomfortable with the situation the driver came back and we bolted away down the bumpy highway again.

When we finally got to Agra, we were starving. Our "guide" who was a part of the taxi service, had us go to a place with "Continental" food cause we said "no Indian please!" Thats all we've been eating, so it was time for a break. During lunch it began to rain. We didn't want to postpone going to the Taj so we decided to just tough it out and head on over.

In an attempt to protect the Taj from pollution, no gas/CNG vehicles are allowed near the property. So you park far away and then electric cars take you to the gates. There are also some camels towing carts, but we opted for the cars.

We paid our IR750 (about USD15), avoided some ginormous puddles, got patted down, and got our bags checked and BAM! We were inside the main red walls of the Taj.

The Great Gate. The building you walk through to get to the Tomb.
The red wall that you can see extending from either side of the Gate Building wraps forward (towards where I took the picture from), and there are little archways and a roof/awnings for the entire length of the red sandstone wall.

As soon as we were done being frisked (a very normal occurrence when going to popular places in India) the rain started really coming down. We sought refuge under the roof of the red walls to see if the rain would stop. It didn't.

We scurried from our spot in the wall around the lawn and squeezed into the Gate Building. This is where you look up above the heads of all of the short Indians and tourists and you are breathless and amazed at the sight you see through the archway.

You can't really tell from the picture, but the sheer size is what hits you first.

It was so rainy that there was a kind of water screen in front of us.

A few of us decided to just brave the rain and venture outside.

But then the rain turned from drops to absolute torrential downpour. We ran up the walkways and into the right side (not in this picture) mosque. There are mosques on either side to help weigh down the floating marble platform that the Tomb (the main white building) sits on. Because the location had experienced a horrible earthquake, the architects planned the platform so there would be less of a chance of it being destroyed. The four minarets are also constructed with a slight lean away from the Tomb so in the case of an earthquake or it they collapsed because they are so tall, they wouldn't affect the Tomb.

The rain just wouldn't let up! I was getting antsy in the mosque and my Oregonian-love-of-rain took over. I decided to go out and dance a bit in front (really the side) of the Tomb.

The scale is so hard to capture. If you see those little dark specs at the base of the Tomb, those are people walking around (in the rain). The carved arches on the base are taller than me.

Because the rain wasn't letting up, we decided to make our way up to the Tomb.

You can't wear your shoes on the marble, so you either have to take them off or put shoes covers on.

When I first made it up the stairs (so much pushing and crowding because no one wanted to be in the rain) I was separated from the three other girls I was with. So, I decided to seek refuge in one of the archways of the Tomb so I could see them when they came up.

To the right is us (our fourth adventurer, Julika, was taking the picture). Here you can see our glamourous shoe covers, the intricate carvings, and the amazing inlays. You also might notice how soaking wet we are.

My sweatshirt is usually a medium colored forrest green, and it was practically black (like my leggings) from all of the rain.

Once we had all recovered from the stairway experience and also taken photos with some of the Indian men sharing our archway (they wanted a full group shot with us girls in between each of them, and each guy wanted a picture with me ... very strange) we decided to make our way to the entrance to the Tomb.

Some of the detail at the entrance to the Tomb.

Don't get me wrong, the inside of the Tomb is cool, but the outside is so much more impressive and interesting than the inside. You could almost visit the Taj without going inside, you wouldn't be missing much. However, I did really like walking around inside and touching all of the carvings and the inlays. It was a really cool feeling to know that I was touching carvings that were made 400 years ago.

When we got out of the Tomb, it was still raining.

This is the crowd at the top of the stairs to the Tomb. You can also see the downpour of rain.
These people were not very Oregonian, they were all using umbrellas.
I wasn't the best Oregonian either through I suppose because I didn't have a raincoat.

There was so much water that even the grounds were flooding.
Eye-spy: The little planters at the center of the "ground" are under the water.

Me (soaking wet) at the Taj!

The nine of us met back up at the Great Gate before heading back to the van. We were completely  soaked (see the "white" pants some of the girls are wearing are now see-through) but being there was an absolutely incredible experience.

On the van ride home.
Notice the new colors in the van now?

Once we got back to the van we decided buying some dry clothes was VERY necessary. The tour guide first took us to this expensive place where we refused to buy anything. So then we found a cheeper place and we all bought some clothes.

We stopped for some food and a bathroom before we left Agra and then we were off, back to Delhi.

The drive home was quite uneventful. We had major girl bonding (aka chatting, gossiping, laughing) but besides that there was no unusual activity. We stopped for the restroom a few times (us girls have small bladders) and a cup of hot coffee/tea/coco and got home around 11pm.

It was an absolutely fantastic day. Some people (like my host dad) expressed their disappointment for us that it was raining when we were there, but I think the rain made the experience better than it would have been otherwise. If it had been sunny I would have simply looked and admired the Taj. But because it was raining, I sought refuge in it. I took the time to really look at the details, be very present in the moments and find the "little" spaces of the Taj that could protect me from the rain. I felt I got to know the Taj in a way that I wouldn't have otherwise - if I had just been "visiting" it.

The Taj Mahal was absolutely magical. I am so glad we made the trip!

First Weekend with The (Host) Fam

While in India, I am living with a host family. To put it simply, THEY ARE AWESOME!

They are super warm and welcoming. We have great discussions every night and they are making me feel right at home.

My dad was trained as a doctor (he has his MD) but now works for the government. He worked in public health for a while, but now is working in the tax department. He has knowledge about everything health, he even gave a lecture at my school this past week about the structure of the health care system in India.

My mom is a homemaker/Bollywood actress. When I first moved in with the family, she was away in Bombay shooting a film (very glamourous). But when she got home she turned out to be just a normal mom.

I also have two siblings, Akshi (20) and Siddarth (18). They are both law students at the law school here in Delhi, Amity Law School. They are hilarious and I love having Indian siblings my age; we have tons of interesting conversations about our respective cultures and comparing the cultures of our generation.

This picture is a little dated, but every time I try to take a new fam pic, there is always some excuse: "I haven't washed my hair" "I haven't shaved today" "I don't like my outfit" ect ect ect.
However, this is pretty much what they still look like. Siddarth just got a hair cut this week, but besides that, they look the same. Siddarth on the far left, then Akshi, Mom, and Dad to the far right.

My first weekend was PACKED! Below are some pictures and explanations.
The first stop was a school that my "Mom's" sister owns/is the principal of. It is in the State of Haryana.

This is the outside of the school. It is sort of an NGO, but it is private so they have to pay -- but there are scholarships. The children that attend are children of illiterate parents. For instance, many of the children's parents are rickshaw drivers.

Scholarships are important, and as you can see on the sign, the kids that get the scholarships are celebrated. Signs are posted to inspire other children to do as well as these lucky few who get the scholarships.

This is the blackboard of one of the classrooms. There is Hindi on the left (would you believe me if I told you I could read it?) and some English on the right.

When visiting the school, "Dad" decided that Noel (the other girl that is staying with our awesome family) and I should teach an english class. Above is us being introduced by "Mom's" sister/the principal to the the 9th grade class that Noel taught.They asked me to write out some words from the story they read (but didn't understand) so that we could discuss the meanings. Writing on a blackboard is hard! The students were so good at it, and I sucked.

This is the 9th grade class that I taught. Noel, "Mom" and I are in the back.

To commemorate our visit/teaching they asked Noel and I to plant a tree. At first they were just having us hold the tree up and having the gardener put the dirt in, but I am an Oregonian; if I'm going to "plant a tree" I am going to plant the tree. So I started putting the dirt in. All of the adults told me not to, but then they found it amusing and Noel joined in too.

These are the school bathrooms. They are in a little court yard, behind the classrooms. I didn't venture into them ...

This is the area outside the school. "Mom's" sister keeps trying to get the land from the government so she can plant trees and make it look nicer, but they refuse to sell it to her.

In the afternoon, Siddarth, Akshi, Noel and I went to Humayun's Tomb. He was a mongol emperor. It was very pretty, and kind of set up like the Taj Majal (which is tomorrow's adventure!).

Me, Noel, and Akshi in front of the main tomb.

I loved all of the stone screens that were in all of the buildings.

The next day (Sunday), we went to a Arts and Craft Bizarre in Haryana with "Mom's" family.

Artisans came from all over the country and there were also some artisans from other countries. It was decorated with tons of color and there were people dressed in traditional costumes, and there were dances and music performances.

Trips to Old Delhi

After class, we like to take little adventures around town. The past two weeks I have ventured out to "Old Delhi," which is about a 40 minute Metro ride.
When you think of India you might imagine people packed together like sardines, but in New Delhi, and especially in the part of town that I live/go to school in, that is not the case; there is a lot of space and I never feel claustrophobic.  That is not the case in Old Delhi. Old Delhi feels and looks like you expect all of India to be: crowded, loud, dusty, and smelly (with good and bad).
Two of the locations I've visited in Old Delhi are the Spice Market and the Red Fort.

Tobias, Priyanka and me walking around finding
the Spice Market.

Michelle and me in a Rickshaw, traveling to the Red Fort.

The view from our rickshaw

The crowed Old Delhi street

The OLD buildings are shmushed together like all the people 

Lots of different activities happen on the street ...

... like medical clinics ... 

... and making garlands.
Eye-spy: See the man making garlands on the right? He saw me taking a picture and gave me and my friend Priyanka each a flower :) It smelled so good, and was a wonderful relief from the stuffy air.
(You can see the flowers in the first pic)

One of the stalls inside the Spice Market. Everyone inside (including the men working there) were constantly coughing because of all of the dust/spice in the air.

Dried fruits and nuts at a stall just outside the Market.
Eye-spy: see the signs, that is the price per kg, so the almonds in the middle row at 600Rupees/kg, is about $5.40/lb
(if I'm doing the conversion right ...)

Some of the fruits, nuts and grains.

A panorama of the Red Fort. We didn't go in because it was too late in the afternoon. But the outside was quite impressive.

Some detail of the Red Fort. It was beautiful and the weather that day was so nice!

Me and some of my travel companions chillin' at the Fort.
Eye-spy: The birds! They were everywhere!